What causes a ulcer

What Causes Ulcers?

People with ulcers can have a wide variety of symptoms. Some people may experience no symptoms at all, or in rare instances can develop life — threatening complications, such as bleeding. Some of the more common symptoms may include abdominal pain, burning, nausea, bloating, fatigue, or black stools.The two most common causes of ulcers are Helicobacter pylori (H. pylori) and non steroidal anti — inflammatory drugs (NSAIDS).

H. pylori is a bacteria which causes ulcers by disrupting the protective mucous layer that lines the intestines. When the mucus layer is disrupted, it triggers the release of certain enzymes and toxins that injure the cells of the stomach or duodenum causing small sores. Once a small sore develops, the tissue becomes more vulnerable to damage from digestive juices and has the potential to develop into an ulcer.

The most common NSAIDS are ibuprofen and aspirin. These types of drugs are taken to decrease inflammation. Inflammation is caused by a natural chemical in the body called prostaglandins. NSAIDS work by inhibiting the body’s production of prostaglandins. However, certain prostaglandins are important in protecting the stomach lining from the corrosive effects of stomach acid, as well as playing a role in maintaining the natural, healthy condition of the stomach lining. By disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding.

Elisa Faybush, MD (bannerhealth.com)

The majority of peptic ulcers are caused by a bacterial infection of the stomach called Helicobacter pylori. This infection is often asymptomatic and can be acquired in childhood. The other cause of ulcers is the regular use of aspirin and anti — inflammatory medicines. There is no evidence that stress causes ulcers. Symptoms of ulcers can include upper abdominal pain, nausea and vomiting, and black, tarry stools (a sign of a bleeding ulcer).

Lisa Ganjhu, DO (wehealnewyork.org)

A gastric ulcer is a sore or scar in the stomach. Taking high — dose aspirin and nonsteroidal antinflammatory drugs like Motrin or Advil usually cause ulcer in the stomach. Ulcers can also be caused by an infection, called H. pylori. Common symptoms of gastric ulcers include weight loss, poor appetite, bloating, burping, vomiting, and sometimes vomiting blood.

Brett Lashner, MD (clevelandclinic.org)

Ulcers of the stomach and duodenum used to be very common, but are now becoming much less common. We used to think that acid caused ulcers and our treatment paradigm was “no acid, no ulcers.” Yes, eliminating acid allowed ulcers to heal, but they came right back after treatment was stopped. We now know that ulcers are principally related to two causes, Helicobacter pylori infection and non — steroidal anti — inflammatory drug (NSAID) use. By eradicating H. pylori with antibiotics, we can eliminate ulcer disease for good. This discovery, that a chronic disease can be cured with antibiotic therapy, led to the awarding of the Nobel Prize in Medicine to Drs. Marshall and Warren in 2005. Interestingly, rates of H. pylori infection are falling, accounting for the lower rates of ulcer disease. Of course, stopping NSAIDs will cure NSAID — induced ulcers. Neither ulcers nor antacid therapy, like proton — pump inhibitors, impact on digesting very much. Digestion occurs more efficiently in the presence of acid, but occurs very well indeed when acid is suppressed.

Andrew Sable, MD (gastrohealth.com)

Most commonly ulcers occur in either the stomach or duodenum (first part of the small intestine). Symptoms usually manifest as pain or burning in your mid to upper abdomen just below the center of your chest. For years it was thought that stress was a major factor in the formation of ulcers. While severe stress experienced form medical illness may increase the risk of ulcer formation, more commonly medication such as NSAIDs (non — steroidal anti — inflammatory medications), the bacteria H. pylori, and smoking are the major risk factors. With the advent of PPIs (proton pump inhibitors) and the understanding of H. pylori, ulcers can usually be treated medically before they affect digestion. On a rare occasion, they may cause obstruction of the stomach, severe bleeding, or perforation of the intestine which may require surgery. In general though, the long term impact on digestion in minimal.

Albert Snow, ND (holisticgastroenterology.com)

First off, let’s not buy into the myth that ulcers are caused by a bacteria called H. pylori. Just not true. Ulcers are caused by the prior use of a medication that destroyed your mucosal lining, thus leaving your stomach tissue exposed to your own digestive acids, which then eat a hole right through the flesh. This is also true of ulcerative colitis. Ulcers don’t impact digestion, but in this scenario digestion impacts the ulcer (creating it).

William Chey, MD (med.umich.edu)

For many years, ulcers were thought to be due to stress or excess amounts of stomach acid. As it turns out, the most common causes of gastic (stomach) and duodenal (first part of the small intestine) ulcers are a specific type of bacteria called Helicobacter pylori and medications, most notably, nonsteroidal anti — inflammatory drugs (NSAIDs) and aspirin. Any person found to have an ulcer should be tested for H. pylori infection and asked about the use of these medications. H. pylori can be tested for using a breath test, by stool testing, or by checking for the bacteria in biopsy specimens from the stomach. This organism is usually treated with a combination of 3 to 4 antibiotics for 10 to 14 days. Curing the infection leads to healing of the ulcer and significantly reduces the likelihood of getting recurrent ulcers. Ulcers related to the use of NSAIDs or aspirin are typically healed with drugs that potently suppress the production of stomach acid called the proton pump inhibitors (PPIs). If a person can discontinue their NSAID or aspirin, a 10 — to 12 — week course of PPI therapy is sufficient to heal the ulcer. If a person needs to stay on an NSAID or aspirin, PPI therapy should be continued to reduce the risk of developing another ulcer.

Jacqueline Wolf, MD (drjacquelinewolf.com)

Stomach and duodenal ulcers are usually due to one of two causes: the bacterium Helicobacter pylori or nonsteroidal anti — inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen. An ulcer, regardless of the cause, can cause abdominal pain, bleeding, or even cause a hole (perforation). An ulcer is maintained by an acid environment in the stomach and pepsin, which is produced in the stomach. Chronic infection with H. pylori causes an increase in acid. There is also a change in some of the cells in the duodenum that is created by the acid change called gastric metaplasia. Additionally the bacteria create an active immune response that could contribute to ulcer formation/inflammation and they appear to decrease the response of protective factors in the lining of the stomach and duodenum. Smoking also increases ulcer formation. NSAIDs, by their effect on prostaglandins, can increase stomach acid, decrease the substances that protect the lining like bicarbonate and glutathione, and can allow the hydrogen ions to diffuse (go) backwards into the stomach lining and decrease the rate of blood flow to the stomach lining.

March 8, 2010 (Issue: 1333) Select a term to see related articles 2010 Aciphex Antacid Antacids Antibiotic Antibiotics Aspirin:133b Nonsteroidal anti-inflammatory drugs Axid Cimetidine Clopidogrel Dipyridamole Duodenal ulcer Duodenal ulcers Endoscopic ulcer Endoscopic ulcers Esomeprazole Famotidine Gastric ulcer Gastric ulcers H pylori H. pylori H. pylori eradication H2 receptor antagonists H2-receptor antagonists Helicobacter pylori Issue 1333 Lansoprazole Losec March 8 Misoprostol Nexium Nizatidine Nonsteroidal anti-inflammatory drug NSAID NSAID-associated ulcers NSAIDs Omeprazole Page 17 Pantoloc Pantoprazole Pariet Pepcid Peptic ulcers Persantine Plavix PPI PPIs Prevacid Prilosec Primary Prevention of Ulcers in Patients Taking Aspirin or NSAIDs Proton pump inhibitor Proton pump inhibitors Protonix Rabeprazole Ranitidine Tagamet Ulce Ulcers volume 52 Zantac Zegerid

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are common causes of peptic ulcer disease. Patients infected with Helicobacter pylori who take aspirin or another NSAID have an especially high risk.1 Drugs that have been tried for prevention of ulcers in patients taking NSAIDs including H2-receptor antagonists, proton pump inhibitors (PPIs), aluminum- or magnesium-containing antacids, the prostaglandin misoprostol (Cytotec ,and others), and antibiotics to eradicate H. pylori.2

H2-RECEPTOR ANTAGONISTS — NSAIDs are more likely to cause gastric than duodenal ulcers. High doses of an H2-receptor antagonist have been shown to prevent NSAID-related gastric ulcers. In a 6-month study in patients on long-term NSAID therapy, famotidine 40 mg twice daily was significantly superior to placebo in preventing gastric ulcers found on endoscopy, which occurred in 20% of placebo-treated patients and 8% of those on famotidine.3 In a 12-week randomized, double-blind trial comparing famotidine 20 mg twice daily to placebo in 404 adult patients taking aspirin 75-325 mg daily with or without clopidogrel (Plavix) or dipyridamole (Persantine, and others), the prevalence of gastric ulcers found on endoscopy was 15% with placebo and 3.4% with famotidine, and that of duodenal ulcers was 8.5% and 0.5%, respectively.4 However, continued use of these agents leads to pharmacologic tolerance and loss of effectiveness over time.2

PROTON PUMP INHIBITORS (PPIs) — A randomized, double-blind trial in 169 patients taking NSAIDs compared omeprazole 20 mg once daily with placebo. After 6 months, the incidence of ulcers seen at endoscopy was 3.6% in the patients on omeprazole and 16.5% in those on placebo.5 A more recent 2-year study (VENUS) found that esomeprazole 20 or 40 mg once daily for 6 months was superior to placebo in preventing ulcers in NSAID users who had additional risk factors such as advanced age or a past history of ulcer; among 844 such patients, endoscopic ulcers developed in 20% with placebo, 5% with esomeprazole 20 mg, and 4% with esomeprazole 40 mg.6 Another trial compared esomeprazole 20 or 40 mg once daily with placebo in patients who were taking aspirin 75-325 mg daily and had one or more additional risk factors for ulceration, such as age over 65 or a past history of peptic ulcer disease; after 26 weeks, endoscopic ulcers were present in 7.4% of placebo-treated patients and in 1.1% and 1.5% of those on esomeprazole 20 or 40 mg, respectively.7

PPIs have been shown to be more effective than H2-receptor antagonists in prevention of NSAID-related ulcers and at least as effective as misoprostol.8,9

MISOPROSTOL — Misoprostol (Cytotec, and others), a synthetic prostaglandin E1 analog, can prevent gastric and duodenal ulcers in patients on chronic NSAID therapy. It may be as effective as a PPI, but requires multiple daily dosing and is not as well tolerated. Abdominal pain and dose-related diarrhea are the most common adverse effects of misoprostol. Nausea can also occur. Misoprostol is an abortifacient and is contraindicated during pregnancy.10

H. PYLORI ERADICATION — A meta-analysis of five prospective trials of H. pylori eradication showed a statistically significant reduction in the risk of endoscopic ulcers in patients who had not yet begun NSAID treatment, but not among those already taking an NSAID.11 The American College of Gastroenterology now recommends considering routine testing for H. pylori before starting long-term therapy with an NSAID.1

ANTACIDS — There is no convincing evidence that long-term use of aluminum- or magnesium-containing antacids can prevent development of peptic ulcers in patients taking aspirin or NSAIDs. Other problems with antacid use are the requirements for multiple daily doses and adverse effects on bowel habits: constipation with aluminum-containing products and diarrhea with magnesium.

CONCLUSION — Taking a proton pump inhibitor can prevent aspirin- or NSAID-associated ulcers detected on endoscopy. To what extent it prevents clinical symptoms or bleeding remains to be determined.

1. FL Lanza et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol 2009; 104:728.

2. Treatment of peptic ulcers and GERD. Treat Guidel Med Lett 2008; 6:55.

3. AS Taha et al. Famotidine for the prevention of gastric and duodenal ulcers caused by nonsteroidal anti-inflammatory drugs. N Engl J Med 1996; 334:1435.

4. AS Taha et al. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebocontrolled trial. Lancet 2009; 374:119.

5. D Cullen et al. Primary gastroduodenal prophylaxis with omeprazole for nonsteroidal anti-inflammatory drug users. Aliment Pharmacol Therap 1998; 12:135.

6. JM Scheiman et al. Prevention of ulcers by esomeprazole in atrisk patients using non-selective NSAIDs and COX-2 inhibitors. Am J Gastroenterol 2006; 101:701.

7. JM Scheiman et al. Prevention of low-dose acetylsalicylic acidassociated gastric/duodenal ulcers with esomeprazole 20 mg and 40 mg once daily in patients at increased risk of ulcer development: a randomized controlled trial (OBERON). Gastroenterology 2009; 136:A-70 (abstract 412).

8. CJ Hawkey et al. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal anti-inflammatory drugs. New Engl J Med 1998; 338:727.

9. DY Graham et al. Ulcer prevention in long-term users of nonsteroidal anti-inflammatory drugs: Results of a double-blind, randomized, multicenter, active- and placebo-controlled study of misoprostol vs. lansoprazole. Arch Intern Med 2002; 162: 169.

10. Misoprostol. Med Lett Drugs Ther 1989; 31:21.

11. M Vergara et al. Meta-analysis: Role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther 2005; 21:1411.

Aspirin, Ibuprofen, and Intestinal Disorders

Ever since aspirin hit the market in the late 1800s, it has been a fixture in medicine cabinets everywhere — and for good reason. It erases headaches, soothes arthritis, lowers fevers, helps prevent heart disease, and may even ward off some types of cancer. If it were discovered today, doctors would hail it as a medical breakthrough.

But for some people, aspirin has a serious downside — especially if taken regularly. At the same time it’s easing your pain, it could be giving you an ulcer. Aspirin is just one of many painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs), which can cause serious damage to your digestive system. Other members of the NSAID class include the over-the-counter pain relievers ibuprofen and naproxen and at least 15 prescription drugs.

According to the American College of Gastroenterology, up to 60 percent of the approximately 14 million patients with arthritis who consume NSAIDs regularly will develop side effects related to the drugs. Although most are minor, side effects may include stomach ulcers, bleeding, holes in tissue, and even death. In December 2004, the FDA warned that one NSAID — naproxen — may be associated with an increased risk of heart problems. The following year, the FDA ordered all manufacturers of prescription and over-the-counter NSAIDs to revise drug labels. The new labeling requirements include boxed warnings that highlight the potential for increased risk of cardiovascular problems and life-threatening gastrointestinal bleeding.

The danger is real. According to Postgraduate Medicine, more than 100,000 Americans are hospitalized each year with intestinal trouble caused by aspirin and other NSAIDs. Fortunately, only a small percentage of cases are fatal.

Why are NSAIDs hard on the stomach?

The drugs cause ulcers by interfering with the stomach’s ability to protect itself from stomach acids, according to the National Digestive Diseases Information Clearinghouse. “Normally the stomach has three defenses against digestive juices: mucus that coats the stomach lining and shields it from stomach acid, the chemical bicarbonate that neutralizes stomach acid, and blood circulation to the stomach lining that aids in cell renewal and repair,” the clearinghouse explains. “NSAIDs hinder all of these protective mechanisms, and with the stomach’s defenses down, digestive juices can damage the sensitive stomach lining and cause ulcers.”

How do NSAIDS undermine the stomach’s defenses? All block an enzyme called cyclooxygenase 1, or COX-1. This enzyme helps prevent ulcers by enhancing blood flow to the stomach and increasing the production of protective mucous. If there’s a shortage of COX-1, your stomach may not develop its usual protective lining, making it more vulnerable to attack by stomach acid.

In most cases, the damage is minor and your stomach heals completely about five days later. Still, regular doses can cause dyspepsia, lingering pain, or discomfort in the stomach. And if your stomach doesn’t heal quite as quickly as it should, you could easily develop an ulcer or serious internal bleeding.

Who is at risk for NSAIDs-related intestinal trouble?

The typical person with NSAIDs-related intestine problems is an arthritis sufferer who takes several pills every day. For some people, however, just one pill each day can be enough to cause trouble. Older people are especially prone to complications of NSAIDs. The risk climbs if you have a history of ulcers, if you’re currently taking corticosteroids or anticoagulants, or if you have a serious illness such as cancer or cirrhosis.

There’s some evidence that smoking and drinking can also increase the likelihood of an NSAIDs-induced ulcer. According to the American Family Physician, alcohol consumption can also increase the risk for major bleeding in the upper GI tract, which includes the esophagus (or gullet), the stomach, and the beginning of the small intestine. In a study of more than 1,200 patients admitted for upper GI bleeding, researchers found that those who drank heavily and used aspirin or ibuprofen regularly had a much higher relative risk of intestinal bleeding. What’s more, this was true even for people who were taking low-dose aspirin. (Because NSAIDs cause system-wide effects, even “enteric-coated” aspirins can cause ulcers.)

What are the symptoms of NSAIDs-related stomach trouble?

NSAIDs can inflict serious damage before they ever cause any symptoms. As reported in Postgraduate Medicine, more than 80 percent of patients hospitalized with serious complications of NSAIDs never notice any warning signs.

For some patients, mild stomach discomfort (dyspepsia) and nausea may be an early sign of trouble. If an ulcer develops, you may feel a gnawing, burning pain in your abdomen. The pain usually comes and goes. You may also feel nauseous and lose your appetite. If the ulcer causes internal bleeding, you may become tired and anemic and your stools may turn black or tarry. If you notice these symptoms, you should seek care right away.

If the bleeding is severe, you could start vomiting bright-red blood and go into shock. Obviously, these are signs of a medical emergency: Call 911 or have someone drive you to an emergency room immediately.

What is the treatment for NSAIDs-related stomach trouble?

For most people, giving up NSAIDs is the key to treatment. If it’s impossible to quit, you’ll have to at least lower the dose. Either way, your stomach will quickly begin to heal. If you have an ulcer, your doctor might speed the recovery by prescribing acid-blocking drugs, proton-pump inhibitors, or other medications. If you are infected with Helicobacter pylori, a bacterium that can irritate the stomach and cause ulcers, your doctor will prescribe antibiotics to wipe out the germs.

If you have serious internal bleeding or a hole in your stomach or intestine, you’ll need treatment that may include endoscopy or surgery.

Can NSAIDs-related stomach trouble be prevented?

One way to avoid NSAIDs-related stomach trouble is to avoid NSAIDs. If you have osteoarthritis, for example, you may be able to control the pain with acetaminophen (Tylenol) and capsaicin creams along with physical therapy and exercise. You might want to ask your doctor about complementary medicine, too: Some research indicates that fish oil supplements might ease inflammation in people with arthritis, for instance, and certain herbs, self-hypnosis, biofeedback, and other alternative therapies may also prove beneficial. Whatever alternative methods you explore, however, be sure to discuss these options with your doctor.

For many people, though, giving up NSAIDs isn’t the best option. Other pain relievers may not be up to the task, and when it comes to preventing heart attacks, aspirin is in a class by itself.

Practically everyone can safely take an NSAID every now and then, but you should talk to your doctor before making it a regular habit. Let your doctor know all the other prescription drugs, herbs, and over-the-counter supplements you’re taking, as well as how much alcohol you drink on a regular basis. If your doctor believes the benefits of NSAIDs outweigh the risks, you can proceed with caution.

If you do start an NSAID routine, think small. For instance, a single baby aspirin (about 80 milligrams) every day can give you strong protection against heart disease with relatively few side effects. Whatever your reason for taking an NSAID, your doctor can help you find the lowest effective dose.

Some NSAIDs are more dangerous than others. If you need a prescription NSAID to fight pain, ask your doctor if you are at high risk for stomach trouble. If so, you should take less harsh drug such as ibuprofen instead of more problematic drugs such as ketorolac tromethamine (Toradol).

If you regularly take a traditional NSAID and are at high risk for ulcers, your doctor may prescribe a medication to protect your stomach. The drug misoprostol (Cytotec) has been shown to slightly reduce the rate of ulcers in long-term NSAID users. However, the minor benefit is coupled with a high incidence of diarrhea and other side effects. Some proton-pump inhibitors, such as Prevacid (lansoprazole) have been approved by the FDA to heal and help prevent stomach (gastric) ulcers due to NSAIDs from coming back.

Alcohol and NSAIDs increase risk for upper GI bleeding. Karl E. Miller, American Family Physician. May 1, 2000.

American College of Gastroenterology. Effects of NSAIDs on the upper gastrointestinal tract. www.acg.org/phyforum/gifocus/2eiv.html

Emery P. Cyclooxygenase-2: A major therapeutic advance? American Journal of Medicine. January 8, 2001. 110(1A): 42S-45S.

Graumlich JF. Preventing gastrointestinal complications of NSAIDs. Postgraduate Medicine. May 2001. 109(5): 117-128.

NSAIDs and Peptic Ulcers. National Digestive Diseases Information Clearinghouse. www.niddk.nih.gov/heath/disgest/summary/nsaids/

FDA Statement on Naproxen. December 20, 2004

Ulcer Disease

Download a pdf of this ulcer disease information.

Ulcer Disease Overview

A peptic ulcer is a sore or break in the lining of any part within the digestive tract that contains concentrated gastric juice. The main components of gastric juice are water, mucus, hydrochloric acid, enzymes, and electrolytes. Ulcers most commonly occur in the first part of the small intestine below the stomach (duodenum), and can occur at the lower end of the esophagus or in the stomach.

Most ulcers result from infection with bacteria called Helicobacter pylori (H. pylori). Contrary to old beliefs, neither eating spicy food nor living a stressful life cause ulcers. H. pylori bacteria weaken the protective mucous coating of the esophagus, stomach, or duodenum, which then allows acid to get through to the sensitive lining beneath. Both acid and H. pylori irritate the lining and cause a sore (ulcer) to form.

It is unclear how these bacteria spread from person to person and why only a small percentage of those who have H. pylori within the stomach go on to develop peptic ulcers. Just because you have H. pylori bacteria populating your stomach does not mean you will get an ulcer, although most diagnosed with ulcers also have an H. pylori infection.

Another cause of ulcers is the regular use of pain medications called non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin and ibuprofen. Frequent or long-time use of NSAIDs, especially among the elderly population, can increase the risk of developing an ulcer.

About 10% of Canadians will experience peptic ulcers at some point throughout their lives.

Ulcer Disease Symptoms

The most common symptom of an ulcer is a burning pain in the upper abdomen, somewhere between the breastbone and the navel. The pain can last anywhere from a few minutes to several hours, often occurs between meals, and can awaken you from sleep. Food or antacids might temporarily relieve the discomfort. Less common symptoms of an ulcer include nausea, vomiting, lack of appetite, and weight loss.

There are three main complications of peptic ulcers: bleeding, perforation, and obstruction.

Bleeding may be the first and only symptom of an ulcer. Bleeding ulcers can cause vomiting of acidified blood that looks like ‘old coffee grounds’ and/or bowel movements that become tarry black. When an ulcer bleeds and continues to bleed without treatment, a person may become anemic and weak.

Perforation can occur when ulcers go untreated, as gastric juices can make a hole through (perforate) the stomach and/or duodenal lining, requiring surgery to close the opening.

Obstruction is a complication that can occur when chronic inflammation from the ulcer causes swelling and scarring. Over time, this scarring may close (obstruct) the outlet of the stomach, preventing the passage of food and causing vomiting and weight loss.

Surgery is required to repair obstructions. It is important to contact a physician immediately if your ulcer symptoms worsen.

Diagnosing Ulcer Disease

The most common tests used to check for the presence of an ulcer are:

Upper GI series: X-rays are taken after the patient swallows a special liquid to coat the esophagus, stomach, and upper part of the small intestine.

Gastroscopy: A physician passes a long flexible tube with a tiny video camera on the end (endoscope) through the patient’s mouth and down the esophagus to the stomach to look for the presence of inflammation or ulcers. If necessary, the physician removes a small sample of tissue (biopsy) for further testing.

Tests for H. pylori: There are several tests available to detect Helicobacter pylori infection. These include a simple breath test, checking the blood for antibodies to the bacteria, or examination of stomach biopsies.

Management of Ulcer Disease

Dietary and Lifestyle Modifications

Physicians often recommend lifestyle and dietary changes for persons with ulcers in addition to medications, until complete healing occurs. Patients should avoid certain foods and beverages such as chocolate, coffee, alcohol, fatty foods, peppermint, citrus fruits and juices, tomato products, pepper, mustard, and vinegar during healing. Eating smaller meals that are more frequent may also control symptoms better. Smoking cessation is important, as smoking inhibits ulcer healing. You should also not take NSAIDs, such as aspirin or ibuprofen. Your physician will probably lift any dietary restrictions once your ulcers have healed.


The cause of your ulcer will determine the type of medical treatment that your physician recommends. If caused by NSAID use, then your doctor may discontinue prescribing NSAID medication, may suggest a different pain medication, or may continue NSAID use and add another medication to protect your stomach and duodenum, such as a proton pump inhibitor (PPI), which blocks stomach acid production.

If H. pylori infection is the cause of your ulcer, then your doctor may prescribe a treatment plan to kill the infection while reducing the acid in your stomach. Usually, this is a combination of one or more antibiotics (to kill the bacteria) plus a PPI. It is important to follow the treatment plan exactly as your doctor prescribes. This treatment can permanently cure 80-90% of peptic ulcers.

Some of the common antibiotic medications prescribed for treatment of ulcers caused by H. pylori infection include amoxicillin, clarithromycin, tetracycline, and metronidazole. It is important to take antibiotic prescriptions until they are complete. This helps prevent the growth of superbugs (more resistant bacteria) that might make subsequent infections more difficult to treat.

Usually a PPI is prescribed along with an antibiotic. The PPIs work by blocking an enzyme necessary for acid secretion. These include omeprazole (Losec®), lansoprazole (Prevacid®), pantoprazole sodium (Pantoloc®), esomeprazole (Nexium®), rabeprazole (Pariet®), pantoprazole magnesium (Tecta®), and dexlansoprazole (Dexilant®).

Ulcer Disease Outlook

Acquiring H. pylori infection during childhood is common and individuals carry it throughout their lives, often without consequence. Transmission within a family is very rare and indiscriminate screening for H. pylori is unnecessary.

To help ensure that you remain ulcer-free, it is important to take all of your medication exactly as your physician prescribes, even if you begin to feel better part way through treatment. Re-infection after successful eradication of H. pylori is uncommon.

Want to learn more about ulcer disease?

We have several related articles that may be helpful:

  • H. pylori May Reduce Esophageal Cancer Risk
  • Diet for Ulcer Disease
  • Physical Activity and GI Health
  • Ulcer Disease
Image Credit: © bigstockphoto.com/GeorgeRudy

Peptic Ulcer Disease

What is peptic ulcer disease?

Peptic ulcer disease is a condition in which there are painful sores or ulcers in the lining of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices. But many things can reduce this protective layer, allowing for ulcers to occur.

Who is more likely to get ulcers?

You may be more likely to develop an ulcer if you:

  • Are infected with the H. pylori bacterium
  • Take NSAIDs (such as aspirin, ibuprofen, naproxen, and many others)
  • Have a family history of ulcers
  • Smoke
  • Have another illness, such as liver, kidney, or lung disease
  • Drink alcohol regularly

What causes ulcers?

No single cause has been found for ulcers. However, it is now clear that an ulcer is created by an imbalance, or unevenness, between the digestive fluids hydrochloric acid and pepsin (a digestive enzyme) in the stomach and duodenum.

Ulcers can be caused by:

  • Infection with a type of bacteria called _Helicobacter pylori (_H. pylori).\
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve®, Anaprox®, Naprosyn®, and others), ibuprofen (Motrin®, Advil®, Midol®, and others), and many others that are available by prescription. Even aspirin that is coated with a special substance can still cause ulcers.
  • Excessive acid production from a condition called Zollinger-Ellison syndrome (gastrinoma). A gastrinoma is a tumor of the acid-producing cells of the stomach that increases acid output.

Can spicy foods cause ulcers?

Though spicy foods can make ulcers more painful, they are not known to cause ulcers.

What are the symptoms of ulcers?

An ulcer may or may not have symptoms. When symptoms occur, they include:

  • A gnawing or burning pain in the middle or upper stomach between meals or at night
  • Bloating
  • Heartburn
  • Nausea or vomiting

In severe cases, symptoms can include:

  • Dark or black stool (due to bleeding)
  • Vomiting
  • Weight loss
  • Severe pain in the mid- to upper abdomen  

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